1790897254 NPI number — MICHAEL W. MOATS, M.D., INC.

Table of content: (NPI 1790897254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790897254 NPI number — MICHAEL W. MOATS, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL W. MOATS, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790897254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454-6953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-922-3632
Provider Business Mailing Address Fax Number:
805-922-3522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-6953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-922-3632
Provider Business Practice Location Address Fax Number:
805-922-3522
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOATS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-922-3632

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  2889069 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CLM334547 . This is a "CLIA REGISTRATION NUMBER- STATE OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D1064504 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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